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A 2-year-old domestic long-haired cat presented with an acute onset grade 3/5 weightbearing bilateral hindlimb lameness. The patient was ambulatory yet pain was elicited in the region of both tarsal joints upon physical examination. No wounds or bruising in the area of either tarsus was detected.
Radiography and assessment under general anaesthesia was performed. Mediolateral and caudocranial radiographs of both hindlimbs were unremarkable, while physical examination under anaesthesia revealed bilateral dorsal tarsometatarsal instability. This was confirmed upon stress radiography (Fig 1a, b). The medial and lateral collateral tarsometatarsal ligaments were intact, while the subluxation and dorsal tarsometatarsal instability resolved spontaneously when the positioning for the stress radiographs was relaxed.
A number of methods of surgical management of this condition have been described and were considered. These included dorsal locking plates (Voss and others 2004), transarticular pins (Chow and Balfour 2012) or via partial tarsal arthrodesis using a laterally applied plate (Dyce and others 1998).
Conservative treatment was felt to be appropriate in this case due to the absence of medial or lateral tarsometatarsal instability, alongside the confirmation of laxity only affecting the short dorsal ligaments: structures only under tension during the swing phase of locomotion.
The patient was discharged with once daily oral 0.05 mg/kg meloxicam (Loxicom 0.5 mg/ml Oral Suspension For Cats; Norbrook), which was continued for 30 days. ‘Cage rest’ within a 2 m diameter footprint cage was advised but poorly adhered to: the patient regularly jumping out over the circular roofless cage.
The patient was reassessed regularly in the weeks following diagnosis and requirement for surgical management was continually reviewed. Due to progressive improvement, surgery was not felt necessary.
At 12 weeks postinjury, there was no residual pain and 0/5 lameness. Orthopaedic examination was performed and no dorsal tarsometatarsal instability was detected while periarticular fibrosis in the region of the tarsometatarsal joint was palpated. Use of both hindlimbs appeared good throughout ambulation and jumping up and down from high surfaces was not obviously compromised (Video 1).
The improvement in lameness and tarsometatarsal joint instability, as described in this case, suggests that conservative management alone may be effective in treating isolated dorsal tarsometatarsal joint instability in cats.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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